Good communication is essential for diagnosis and the establishment of a treatment plan. Research into medical communication is flawed at the moment due to uncertainty about how to interpret contradictory results (1), no explicit long-term or short-term effects (2) and no differentiation between the elements of communication (3).
Bird’s model of medical communication states that a medical interview has the functions of gathering biological and psychosocial data (1), responding to the patient’s emotions (2) and educating patients and influencing their behaviour (3). The three functions model states that the three functions of a medical interview are the need to determine and monitor the nature of the health problem (1), the need to develop, maintain and conclude the therapeutic relationship (2) and the need to carry out patient education and implementation of treatment plans (3).
The five functions model states that the five functions of a medical interview are relationship building (1), information exchange (2), decision making (3), giving advice (4) and handling emotions (5). The framework for patient centred communication states that the functions of a medical interview are fostering relationships (1), information exchange (2), making decisions (3), enabling self-management (4), responding to emotions (5) and managing uncertainty (6).
The six functions model of medical communication states that the six functions of a medical interview are fostering the relationship (1), gathering information (2), providing information (3), decision making (4), enabling disease and treatment-related behaviour (5) and responding to emotions (6).
Information gathering refers to accurate data collection, efficient data collection and determining the nature of the patients’ problems. Information provision refers to the process in which information is conveyed. Information is given because it clarifies the patients’ health problem (1), it is the basis for decision making (2), it reduces uncertainty (3) and it supports coping efforts (4).
Outcomes refer to observable consequences of prior activity occurring after an encounter or after some portion of the encounter is completed. Outcomes can be relevant to the patient (1), the healthcare provider (2) or the process (3). Surrogate outcomes are outcomes that have no value on their own but are assumed to have a direct relation to relevant long-term outcomes (e.g. time to progression in cancer).
Immediate endpoints (i.e. outcomes) are relevant within the medical encounter. Intermediate endpoints (i.e. outcomes) are relevant shortly after the encounter. Long-term endpoints (i.e. outcomes) are relevant a long time after the encounter (e.g. intervention effectiveness on disease). Intermediate endpoints may be surrogate endpoints.
| | Goals | Immediate endpoint | Intermediate endpoint | Long-term endpoint |
1 | Fostering the relationship | Good and effective relationship | Patient participation | Satisfaction with consultation | Patient satisfaction |
2 | Gathering information | Adequate diagnosis | Expression of patient concerns. | Adequate diagnosis | Patient health |
3 | Providing information | Good information provision | Checking of understanding | Understanding | Patient autonomy |
4 | Decision making | Decision based on information and preferences | Checking of decision-making preference | Satisfaction with decision | Satisfaction with decision |
5 | Enabling disease & treatment related behaviour | Adequate and feasible disease and treatment-related behaviour | Addressing patient motivation and efficacy | Treatment adherence | Patient health |
6 | Responding to emotions | Supporting the patient, enhancing the communication and referral where needed. | Patient expression of emotions | Patient sense of support | Patient emotional adjustment |
Quality of life refers to subjective or perceived health. In end-of-life care, good patient communication may lead to a shorter life due to listening to the treatment preferences of these patients. The quality of communication is also relevant for the stress levels of the health-care provider (e.g. burnout).
Health should be the endpoint of good medical communication in the long-run. Intermediate endpoints should lead to improved health rather than be healthy by themselves. Assessing intermediate endpoints can be very important if they have a direct relationship with long-term endpoints (e.g. stopping with smoking and cardiovascular disease). The importance of weight given to an endpoint can depend on preferences. Different endpoints are not always congruent (e.g. patients and doctors may have different goals).
Theory may help to predict what skills or behaviours during the medical encounter will promote other relevant ones. Theory can also predict or explain how these behaviours relate to intermediate endpoints. Furthermore, theory can link intermediate endpoints to long-term ones.
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